1. Master in medical and surgical nursing
Esophagus cancer
Presented by
Qassim j. oddaa
Master in medical and surgical nursing

2. Esophageal cancer
 is cancer arising from the esophagus - the food pipe that runs between the throat and the stomach. The main Symptoms often include difficulty in swallowing and weight loss

3. The two main sub-types of the esophagus cancer are
1-Esophageal squamous-cell carcinoma (ESCC)
more common in the developing world,
Squamous-cell carcinoma arises from the epithelial cells that line the esophagus.
Causes of the squamous-cell type include tobacco, alcohol, very hot drinks, poor diet, and chewing

4. The two main sub-types of the esophagus cancer are
Esophageal adenocarcinoma (EAC)
less common types also occur
arises from glandular cells present in the lower third of the esophagus, .
The most common causes of the adenocarcinoma type are smoking tobacco, obesity, and acid reflux

5. Sings and symptoms
Narrowing of the esophagus due to the physical presence of the tumor
Difficulty in swallowing
Pain when swallowing 
 Weight loss 
Reduced appetite and malnutrition 
 Pain behind the breastbone 

6. Signs and symptoms Nausea and vomiting
Regurgitation of food and coughing.
Vomiting of blood.
Upper airway obstruction 
pain region around the stomach 
Feels heartburn.
Hoarse-sounding

7. Causes of esophagus cancer
Poor oral hygiene
Tobacco (smoking or chewing) and alcohol.
Chewing betel nut (areca) is an important risk factor in Asia.
Physical trauma may increase the risk include the drinking of very hot drinks.
obesity.
The long-term erosive effects of acid reflux as gastroesophageal reflux disease or GERD
Chronicesophagus  inflammatory 
Helicobacter pylori 
 gastric cancer

8. Diagnosis test of esophagus
 barium swallow or barium meal, the diagnosis is best made with an examination using an endoscope. This involves the passing of a flexible tube with a light and camera down the esophagus and examining the wall, and is called an esophagogastroduodenoscopy. 
Biopsies taken of suspicious lesions are then examined histologically for signs of malignancy.

9. Diagnosis
Computed tomography (CT) of the chest, abdomen and pelvis can evaluate whether the cancer has spread to adjacent tissues or distant organs (especially liver and lymph nodes).

10. Stage of esophagus cancer
Any stage of cancer classify according T.N.M which include
T: Tumore invasion
N:Lymph node
M: distant metastasis
Stage one – cancer only in esophagus not metastasis to other part involve out layer
Stage two – cancer not metastasis to other part but involve out, middle and inter layer
Stage three – cancer metastasis to lymph node
Stage four – cancer metastasis to lymph node and near parts such as stomach

11. Treatment of esophagus cancer
1- Surgery
Esophagectomy is the removal of a segment of the esophagus; as this shortens the length of the remaining esophagus, some other segment of the digestive tract is pulled up through the chest cavity and interposed.

12. Treatment of esophagus cancer
2- Chemotherapy and radiotherapy
Chemotherapy depends on the tumor type, giving every three weeks
Radiotherapy is given before, during, or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localised disease but contraindications to surgery,

13. Treatment of esophagus cancer
Laser therapy is the use of high-intensity light to destroy tumor cells while affecting only the treated area. This is typically done if the cancer cannot be removed by surgery. The relief of a blockage can help with pain and difficulty swallowing. 4- Photodynamic therapy, a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells.

14. Complication of esophagus cancer
Aspiration pneumonia
Pleural effusion
Airway obstruction
Death
Metastasis to stomach

15. Typhoid fever
also known simply as typhoid, is a bacterial infection due to Salmonella typhi that causes symptoms. Symptoms may vary from mild to severe and usually begin six to thirty days after exposure. Often there is a gradual onset of a high fever over several days.

16. Clinical feature Fever bradycardia malaise headache cough
A bloody nose (epistaxis)
Abdominal pain
Delirium 
Rose spots appear on the lower chest and abdomen

17. Diagnosis of typhoid fever
Blood test
 Bone marrow aspiration  
 Stool cultures 
Widal test
(demonstration of antibodies against Salmonella antigens )

18. Treatment of typhoid fever
Treatment underlying causes such as fever and loss appetite
Keep taking the prescribed antibiotics for as long period
Wash the hands carefully with soap and water after using the bathroom, and do not prepare or serve food for other people.
Perform a series of stool cultures to ensure that no Salmonella Typhi bacteria remain in the body.

19. Complications of typhoid fever
Hepatosplenomegaly
Intestinal haemorrhage 
peritonitis .
Encephalitis
Respiratory diseases such as pneumonia and acute bronchitis
Cholecystitis, endocarditis, and osteitis
Dehydration